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Abstract

Clinical costing is a powerful tool to bridge the disconnect between financial and clinical information, and is an ideal platform to conduct research aimed at informing value-based clinical decision making. This chapter will provide an example of the utility of activity-based costing to elucidate the costs of complications following pancreaticoduodenectomy, a high acuity procedure with high costs. It will show the significance of clear clinical costing in targeting cost containment in a tertiary hospital environment.

Main Focus Of The Chapter

Objectives

Our primary objectives were to determine the health economic burden of complications, measured using the Clavien-Dindo classification scheme (Dindo, Demartines, & Clavien, 2004), of PD patients presenting to a high-volume tertiary teaching hospital. In addition, the authors examined the genesis of cost differentials between complicated and uncomplicated stays. Secondary objectives were to identify patient and anaesthetic factors that may influence clinical and economic outcomes.

Our study was conducted to confirm the hypothesis that hospital costs for PD are increased with both severity and number of complications. The authors also conducted exploratory analyses to generate hypotheses related to the relationship between complications and specific cost centres.

Methods

Study Design

The study was approved by the Austin Health Human Research Ethics Committee. This cohort study considered the index admission and any 30-day readmissions for patients with and without complications following PD.

Setting

The authors considered patients undergoing PD between July 2011 and December 2016 at Austin Hospital, a university hospital with a high-volume hepato-pancreaticobiliary service. Data relating to their preoperative, intraoperative and postoperative details was collected from a prospectively maintained electronic medical database. Collected data included patient demographics, American Society of Anesthesiologists (ASA) class, preoperative blood values, comorbidities, pathological diagnosis, intraoperative and postoperative fluid balance, operation duration, usage of blood products, 30-day readmissions, and the presence and grade of any complications.